Journal of Neuro-Oncology

Background/ObjectivesGlioblastoma is an aggressive primary brain tumor that develops within a chronically low-oxygen microenvironment, yet most preclinical studies are performed under atmospheric oxygen conditions that poorly reflect in vivo physiology. This study investigated how sustained culture under physiological oxygen tension (physioxia; 5% O{square}) influences glioblastoma cell behavior, signaling, and therapeutic response. MethodsMultiple patient-derived glioblastoma models were cultured under normoxia (21% O{square}) or sustained physioxia (5% O{square}) for at least seven days before experimentation. Cell migration, proliferation, cell cycle distribution, expression of the epithelial-to-mesenchymal transition-associated transcription factor Slug (SNAI2), PDGFR{beta}-associated signaling, and sensitivity to 5-fluorouracil were evaluated using transwell migration assays, cell counting, flow cytometry, RT-qPCR, immunoblotting, and BrdU incorporation assays. Additional patient-derived cultures established and maintained continuously under physioxia were used to examine the effects of oxygen history. ResultsSustained physioxia consistently increased migration across all glioblastoma models while reducing proliferation in normoxia-adapted cell lines through increased G0/G1 cell cycle arrest. Physioxia significantly increased Slug expression in all models and enhanced PDGFR{beta}, AKT, and ERK phosphorylation in a cell line-dependent manner. Therapeutic sensitivity to 5-fluorouracil was also altered, with physioxia conferring increased resistance in selected glioblastoma models but not universally. Patient-derived cultures maintained continuously under physioxia retained enhanced migratory capacity and exhibited increased proliferation compared with normoxia, indicating that prior oxygen exposure influences proliferative responses while the pro-migratory phenotype remains conserved. ConclusionsPhysiological oxygen tension is a major regulator of glioblastoma cell behavior, influencing migration, proliferation, signaling, and therapeutic response. These findings demonstrate that conventional normoxic culture conditions can obscure biologically relevant phenotypes and support incorporating physioxia into experimental design to improve the physiological and translational relevance of preclinical glioblastoma research.

The role of cancer-associated fibroblasts (CAFs) in glioblastoma remains unclear, as their existence in the brain tumor microenvironment is still debated, given that the normal brain parenchyma is devoid of fibroblasts. It is unclear whether cells described as CAFs represent a distinct stromal population or a transcriptional state of perivascular cells such as pericytes. The aim of this study was to determine the identity, origin, and functional relevance of CAFs in glioblastoma. We analyzed 54 single-cell RNA sequencing datasets together with 88 bulk RNA sequencing samples. We identified a continuous transcriptional spectrum linking endothelial cells, pericytes, and CAFs, supporting pericytes as the most likely source of CAFs in glioblastoma. We further derived and validated robust CAF- and pericyte-specific gene signatures, enabling clear separation of these populations across cohorts. Reproducible CAF-associated ligand-receptor interactions were enriched in angiogenesis and immune modulation pathways. In bulk RNA-seq data, both CAF signature scoring and deconvolution consistently demonstrated increased CAF abundance in IDH-wildtype gliomas and further enrichment after chemoradiotherapy, while selective CYP1B1 expression in CAFs suggested a potential association with therapy-induced tumor adaptation. Overall, CAFs represent a distinct, pericyte-related stromal population in glioblastoma with conserved transcriptional and signaling programs. High CAF signature scores were associated with poorer overall and progression-free survival and were enriched in IDH-wildtype and post-chemoradiotherapy gliomas, suggesting a role for CAFs in therapy-associated remodeling of the tumor microenvironment in aggressive disease.

AbstractThe infiltrative, non-enhancing margin of IDH wildtype high grade glioma (IDHwt HGG) harbors distinct molecular programs that drive invasion and therapeutic resistance, yet remains largely unevaluable by conventional tissue sampling approaches and by conventional imaging. Here we show that this invasive architecture is encoded within multiparametric MRI (mpMRI) feature relationships and can be decoded using a graph-based framework trained on multiregional image-localized biopsies. Across 134 spatially matched biopsy-imaging pairs from 35 patients with primary IDHwt HGG (29 glioblastomas (GBM) and 6 non-glioblastoma HGGs), unsupervised graph community detection identifies two imaging-defined clusters that localize to invasive tumor regions without molecular supervision. Transcriptomic profiling associates these clusters with neuronal (NEU) and glycolytic-plurimetabolic (GPM) molecular programs. Building on this framework, a graph convolutional network (GCN) accurately predicts NEU and GPM transcriptional states in independent training and validation cohorts and significantly outperforms conventional convolutional neural networks. Applied to whole-tumor mpMRI volumes, the trained GCN generates spatially resolved probability maps that quantify the distribution and relative burden of NEU and GPM programs across both MRI contrast-enhancing and non-enhancing invasive regions. These imaging-derived molecular maps stratify patients by overall survival. Increased GPM burden is associated with poorer survival, consistent with the aggressive behavior associated with mesenchymal-like transcriptional programs in IDHwt HGG. In contrast, increased NEU burden is associated with improved survival, identifying a previously unrecognized imaging-derived prognostic biomarker that was not detected by biopsy-based molecular classification alone. Together, these findings establish a graph-based imaging framework for spatially resolved molecular classification of invasive IDHwt HGG and demonstrate that whole-tumor molecular state architecture carries prognostic information beyond conventional tissue sampling.

Malignant brain tumors are among the most aggressive and difficult to treat human cancers. Glioblastomas (World Health Organization grade IV gliomas) are particularly lethal and refractory to treatment. Few drugs exist that are even somewhat effective. Our investigation of the physiologic role of fatty acid (FA) activating enzymes (acyl-CoA synthetase; ACS) identified an ACS that was widely expressed in gliomas but not in normal glial cells. Depletion of this enzyme, ACSVL3 (very long-chain ACS3), by knockdown or knockout decreased the malignant behavior of several glioma cell models including U87MG and Mayo-22 cells both in culture and when grown as xenografts. Hypothesizing that ACSVL3 is a potential therapeutic target in glioma, we conducted a search for inhibitors of this enzyme and found that CB5 (grassofermata) was a promising candidate. Treating U87MG glioma cells with CB5 slowed growth in monolayer culture; the growth rate was similar to that seen in cells in which ACSVL3 was either knocked down or knocked out. CB5 inhibited growth in a dose-dependent manner over a narrow range, and concentrations above 10 M were toxic. Treatment at the lower dose of 3 M inhibited growth of U87MG cells but was reversible, suggesting that this dose was not toxic. CB5- treated U87MG cells exhibited an altered morphology with a larger size and longer projections. In contrast, normal human fibroblasts treated with 10 M CB5, a concentration that was toxic to U87MG cells, showed no effect on either growth rate or morphology. Treating U87MG cells with 3 M CB5 induced differentiation as shown by increased expression of the astrocyte-specific marker glial fibrillary acidic protein (GFAP). In contrast, GFAP levels remained low in ACSVL3 knockdown cells. CB5- treated U87MG cells were less invasive, and thus less malignant, than either untreated cells or ACSVL3 knockout cells when assessed by a scratch wound healing assay. Acute treatment of U87MG cells with 3 M CB5 decreased the ability of these cells to degrade FA of differing chain lengths from 16-24 carbons by {beta}-oxidation, suggesting that decreased ACS enzyme activity contributes at least in part to the drugs mechanism of action. NOD/SCID mice receiving up to 32 mg/kg/day CB5 by intraperitoneal injection showed no obvious side effects, suggesting that the drug was well-tolerated. Xenografts induced by subcutaneous injection of U87MG cells in the flanks of NOD/SCID mice were allowed to grow for 8 days after which half of the mice were treated with 2 mg/kg/day CB5. After 7 days of treatment, xenograft growth slowed in the treated mice and by 12 days tumor size had begun to decrease, suggesting therapeutic efficacy. When a similar study was done using xenografts induced by subcutaneous injection of Mayo-22 cells, which are maintained as subcutaneous tumors in mice rather than in cell culture, the effect of CB5 on tumor growth or weight at sacrifice was not statistically significant. The results of these studies suggest that CB5 may have therapeutic value in malignant glioma. Additional studies using other glioma models and other drugs chemically related to CB5 seem warranted.

BackgroundMethyltransferase-like 1 (METTL1) is highly expressed in organs like the pancreas but less so in the brain. The METTL1-WDR4 complex catalyzes N7-methylguanosine (m7G) methylation in tRNA, miRNA, mRNA, and rRNA, which impacts RNA stability and function. These modifications affect mRNA translation and tRNA functionality, influencing protein production and cellular activities. Such modifications can regulate tumor growth, invasion, and metabolism by selectively controlling protein expression. MethodGene expression data from public databases were analyzed to compare METTL1 expression in normal and tumor tissues. Western blot (WB) and immunohistochemistry (IHC) were used to quantify METTL1 levels in glioma samples and assess their prognostic significance. Cell viability, migration, invasion, and proliferation were evaluated using Cell Counting Kit-8 (CCK-8), wound healing, Transwell, cell cycle analysis, and colony formation assays. RNA immunoprecipitation PCR (RIP-PCR) identified m7G methylation sites on EPHA2 mRNA, and RNA stability was assessed with actinomycin D. ResultsBioinformatics analysis revealed that METTL1 is overexpressed in gliomas, correlating with poor prognosis. Knockdown of METTL1 significantly affected cell proliferation, migration, and invasion. RNA sequencing (RNA-seq) and m7G analysis identified EPHA2 as a downstream target, influencing the cell cycle via the AKT pathway. RIP and methylated RNA immunoprecipitation (MeRIP) confirmed two m7G sites on EPHA2 mRNA regulated by METTL1. Small interfering RNA (siRNA)-mediated METTL1 knockdown in EPHA2 mutants affected mRNA stability. Rescue experiments restored cell proliferation and AKT pathway gene expression. ConclusionMETTL1 methylates EPHA2 mRNA, enhancing its stability and expression, which activates the AKT signaling pathway and influences glioma cell proliferation. METTL1 could be a potential therapeutic target in glioma treatment.

Context. Teprotumumab (TEP) is an emerging treatment for thyroid eye disease (TED), but real-world evidence outside the United States remains limited, and detailed changes in orbital components have not been fully clarified. Objective. To evaluate the effectiveness of TEP based on clinical manifestations and magnetic resonance imaging (MRI) findings, and compare it with that of intravenous glucocorticoid (IVGC) therapy. Methods: The TEP cohort included all 18 patients who started TEP therapy at Kyoto University Hospital by July 31, 2025. A historical IVGC cohort included 20 patients matched to the TEP cohort. Results: During 24 weeks of TEP therapy, proptosis measured using a Hertel exophthalmometer improved from 22 (20-22) to 19 (16-21) mm (p = 0.025), and clinical activity score decreased from 4 (3-5) to 1 (0-1) point (p < 0.001). Among 15 patients with diplopia, a reduction of at least 1 point in Gorman score was observed in 9 patients (60.0%). Thyroid-stimulating antibody titers decreased from 1,180% (349-4,710) to 282% (132-504) (p = 0.013). MRI-based comparisons with the IVGC cohort showed that TEP reduced both extraocular muscle and orbital fat areas, whereas IVGC reduced extraocular muscle area but conversely increased orbital fat area. Inflamed extraocular muscles identified on MRI were enlarged at baseline and showed marked shrinkage after both therapies. Conclusion: TEP showed robust effectiveness in Japanese real-world patients with TED. MRI-based analyses revealed distinct effects of TEP and IVGC on orbital fat and identified inflamed extraocular muscles as treatment-responsive components.

BackgroundDiffuse midline glioma (DMG) is a lethal pediatric brain tumor driven by the H3K27M oncohistone, which disrupts epigenetic regulation and promotes tumor proliferation. While prior studies show that H3K27M is essential for tumor initiation, its role in established tumors, tumor microenvironment (TME) regulation, and therapeutic response remain unclear. MethodsHere, we developed inducible and reversible H3.3K27M and H3.1K27M cell and mouse models to study oncohistone-dependent effects on tumor growth, recurrence, and the immune/stromal microenvironment. We generated a tetracycline-inducible PiggyBac-based oncohistone expression cassette in patient- and murine-derived models and validated inducible and reversible H3K27M expression. ResultsRe-expression of H3K27M in knockout cells induced morphological changes and suppressed astrocytic markers. Chromatin accessibility profiling revealed distinct states between ON, OFF, and OFF-ON groups, including PD1-mediated immunosuppressive mechanisms associated with H3K27M expression. Single-cell RNA sequencing demonstrated that the oncohistone reshapes the TME. H3K27M expression promotes tumor-neuron interactions, enhances neuronal excitability, excitatory/inhibitory imbalance, and synaptic connectivity that supports tumor proliferation. These effects are associated with increased glutamatergic signaling and enhanced tumor-neuron coupling through glutamate transport and receptor pathways, including EAAT1 (SLC1A3) and AMPARs (GRIA3). Conversely, H3K27M inhibition reduces neuronal excitation, disrupts tumor-associated signaling, and partially restores neuron-neuron and neuron-immune communications. These findings identify H3K27M as a key driver of excitatory neuron-to-tumor coupling and immunosuppression in DMG. ConclusionsOverall, our findings demonstrate that H3K27M extensively reshapes TME in DMG and support direct oncohistone targeting as a potential therapeutic strategy, including potential CRISPR-based or small-molecule approaches for patients with H3K27M-mutant DMG. Key PointsO_LIWe developed inducible and reversible H3K27M DMG models to investigate the role of H3K27M in the tumor microenvironment. C_LIO_LIH3K27M promotes tumor-neuron communication, while its inhibition disrupts these interactions, supporting H3K27M-targeted therapies for DMG. C_LI Importance of StudyDiffuse midline glioma (DMG) remains one of the deadliest pediatric brain tumors, with limited effective treatment options and poor patient survival. Although the H3K27M oncohistone is recognized as a key driver of tumor initiation, its role in maintaining tumor progression and shaping the tumor microenvironment is unclear. In this study, we developed inducible and reversible H3.3K27M and H3.1K27M murine and patient-derived DMG cell- and mouse-models that enabled precise control of the oncohistone expression. Using these models, we demonstrate that H3K27M actively promotes tumor-neuron interactions, neuronal excitability, and glutamatergic signaling pathways that support tumor growth. Importantly, inhibition of H3K27M disrupted these tumor-associated signaling networks and partially restored neuron-immune communication within the tumor microenvironment. Together, these findings demonstrate that H3K27M extensively reshapes the tumor microenvironment in these Diffuse Midline Gliomas and provides strong rationale for directly targeting the oncohistone as a therapeutic strategy for patients with H3K27M-mutant DMG. Lay SummaryDiffuse Midline Glioma (DMG) is a devastating childhood brain cancer. Despite decades of research, radiation remains the primary treatment and provides only temporary benefit. Most DMGs carry a mutation called H3K27M, which is an attractive target for new treatments such as directly inhibiting or removing this mutation using gene-editing. However, it remains unclear whether inhibiting H3K27M alone will be sufficient to stop the growth of established tumors. In this study, we developed human and mouse models that allow H3K27M to be turned on and off. We found that H3K27M helps tumors communicate with surrounding cells, particularly neurons. Inhibiting H3K27M disrupted tumor-promoting interactions and partially restored normal communication, supporting direct H3K27M-targeted therapies as a promising strategy for children with DMG.

Glioblastoma remains a highly aggressive and therapy-resistant brain tumor, with limited benefit from the current standard-of-care regimen combining surgery, radiotherapy, and temozolomide. Overcoming chemoresistance therefore represents a critical unmet clinical need. Here, we investigate the anticancer potential of Succisa pratensis and its ability to enhance TMZ efficacy in GBM models. Treatment with S. pratensis markedly reduced cell proliferation and migration while significantly increasing sensitivity to TMZ. Integrated multi-omics analyses revealed extensive metabolic rewiring, characterized by suppression of central carbon metabolism and activation of stress-adaptive pathways. Mechanistically, we identify the Pregnane X Receptor, a key regulator of drug metabolism and chemoresistance, as a central node affected by treatment. Although S. pratensis increased PXR expression, this was not accompanied by induction of canonical downstream targets, including MDR1 and ALDH1A1, indicating a functional impairment of PXR transcriptional activity. Consistently, pharmacological inhibition of PXR using the antagonist SPA70 further potentiated the cytotoxic effects of S. pratensis and TMZ. Docking analyses suggest that specific secondary metabolites, including apigenin-derived compounds, may interact with the PXR ligand-binding domain, providing a potential molecular basis for this effect. Collectively, our findings indicate that S. pratensis enhances TMZ efficacy by inducing metabolic vulnerability and functionally impairing PXR signaling. These results highlight the therapeutic potential of plant-derived metabolites as adjuvant strategies to overcome chemoresistance in glioblastoma. Article HighlightsO_LISuccisa pratensis enhances temozolomide efficacy in glioblastoma by reducing proliferation, migration, and clonogenic growth. C_LIO_LIIntegrated proteomic and metabolomic analyses reveal extensive metabolic rewiring, with suppression of central carbon metabolism and induction of stress-adaptive pathways. C_LIO_LIPregnane X Receptor (PXR), a key regulator of chemoresistance, is functionally impaired despite increased expression, resulting in reduced activation of drug-resistance genes. C_LIO_LIPharmacological inhibition of PXR further potentiates the antitumor effects of Succisa pratensis and temozolomide, promoting apoptotic cell death. C_LIO_LIApigenin-derived metabolites show high affinity for the PXR ligand-binding domain and emerge as promising candidates to overcome temozolomide resistance in glioblastoma. C_LI

BackgroundGlioblastoma (GBM) invasion is clinically decisive but difficult to model systematically. Existing patient-derived xenograft (PDX) resources rarely couple reproducible in vivo invasion phenotypes with matched multi-omic profiles at scale, limiting mechanistic insight and phenotype-informed therapeutic hypotheses. MethodsWe established the HGCC Phenobank, comprising 65 patient-derived GBM stem-like cultures with matched multi-omic profiling and orthotopic engraftment in 449 mice. Blinded histopathology quantified ten invasion traits per case. These phenotypes were integrated with RNA sequencing, DNA methylation, and mass-spectrometry-based proteomics. Multi-Omic Factor Analysis (MOFA) identified latent molecular programs. Phenotype-specific RNA signatures were matched to LINCS drug-perturbation profiles and validated in 3D gliomasphere and ex vivo brain-slice assays. ResultsTwo dominant, reproducible invasion modes emerged across models: diffuse parenchymal infiltration and perivascular/condensed growth. Proneural cultures formed more aggressive tumors in immunodeficient mice, and mouse survival showed a modest correlation with patient survival in matched cases (Pearson r = 0.1832, p = 0.045). MOFA identified 15 latent factors; Factor 1, enriched for ASCL1/OLIG1/OLIG2 programs and associated with TP53/DCHS2/WNK2 alterations, was linked to increased tumor formation, diffuse invasion, and shorter mouse survival, and stratified GBM patients in TCGA and in our matched patient cohort. Drug-signature matching separated mechanisms targeting diffuse versus perivascular invasion. Experimental validation confirmed phenotype-selective sensitivities, and inhibitors PIK-75 and buparlisib suppressed invasion dynamics across representative models in 3D and brain-slice assays. ConclusionsThe HGCC Phenobank provides the first openly available PDX resource that systematically links GBM invasion phenotypes to multi-omic programs and therapeutic predictions. This framework enables reproducible model selection, mechanistic dissection of invasion modes, and phenotype-guided therapeutic discovery. Key PointsO_LIDiffuse and perivascular invasion define orthogonal GBM axes C_LIO_LIASCL1/OLIG factor links initiation, diffuse growth, and survival C_LIO_LIPhenotype-matched drugs validated; PIK-75 and buparlisib curb invasion dynamics C_LI Importance of the StudyGlioblastoma invasion varies substantially between patients, yet existing patient-derived xeno-graft resources rarely combine reproducible in vivo phenotyping with matched multi-omic profiling at scale. The HGCC Phenobank addresses this gap with standardized, blinded scoring of ten invasion traits across 449 orthotopic xenografts from 65 molecularly characterized GBM stem-like cultures, integrated with transcriptomic, methylomic, and proteomic data. We identify two dominant, reproducible invasion modes and a cross-modal neurodevelopmental program, the ASCL1/OLIG1/2-associated Factor 1, that links tumor initiation, diffuse growth, and survival in mice, and stratifies GBM patients in TCGA and in our matched patient cohort. In a spatially resolved xenograft section, Factor 1 signal localizes to the invasive tumor periphery. By matching phenotype-specific RNA signatures to drug-induced transcriptional responses, we show that invasion phenotypes nominate selective vulnerabilities, exemplified by PIK-75. This openly shared resource enables reproducible model selection, mechanistic dissection of invasion programs, and phenotype-guided therapeutic discovery.

While recent therapeutic advances have extended the survival of patients with non-small cell lung cancer (NSCLC), overcoming metastatic progression in the CNS remains a significant challenge. Some patients with NSCLC may require concurrent management of CNS and extracranial metastases, while others develop isolated brain metastasis or leptomeningeal disease. These heterogenous clinical outcomes are difficult to predict and diagnose for early intervention with current surveillance modalities. Herein, we comprehensively analyzed gene mutations, copy number variations, and DNA methylation of NSCLC brain metastasis tissue collected at the time of craniotomy, combined with ctDNA sequencing of paired plasma and CSF liquid biopsies. We confirmed a high concordance between the molecular features of brain metastasis tissue with ctDNA from CSF which were largely distinct from ctDNA alterations in paired plasma samples. Plasma ctDNA tumor fraction and ctDNA hypermethylation were most significantly associated with extracranial metastasis and overall survival. Alternatively, we identified specific hypermethylated DNA loci in brain metastasis tissue and CSF ctDNA as significant correlates of brain metastasis progression and risk of leptomeningeal disease. Our findings support the utility of integrating ctDNA testing from CSF and plasma, while revealing distinct epigenetic features and biomarkers of brain metastasis or leptomeningeal disease.

Emerin (EMD), an inner nuclear membrane protein essential for nuclear architecture integrity, gene expression, cellular signaling, and chromatin stability, interacts with the LINC complex and participates in cytoskeleton-nucleoskeleton communication by binding to nuclear actin filaments. EMD is implicated in migration, invasion, and metastasis in some tumors, but its role in glioblastoma (GBM) remains unclear. This study evaluated the effects of EMD knockdown and overexpression in GBM cell lines following genotoxic treatment with cisplatin. In both wild-type p53 (U87-MG) and mutant p53 (U138-MG) GBM cells, EMD expression is high, and cisplatin treatment did not affect these protein levels. EMD knockdown in U87-MG cells significantly increased cisplatin IC50, viability, and proliferation. Conversely, stable overexpression of EMD in U87-MG cells led to reduced cisplatin IC50, viability, proliferation, and migration. EMD knockdown or overexpression did not affect any U138-MG phenotypes, with or without cisplatin treatment. Modulation of EMD levels causes morphological changes in stress fiber cytoskeleton, whereas overexpression of EMD in U87-MG cells promotes an increase and a decrease in nuclear and cytoplasmic actin levels, respectively. These biological responses of U87-MG cells overexpressing EMD were coincidentally associated with alterations in the levels of pH2AX(Ser139), p-p53(Ser15), p53, and p21Kip1 proteins after cisplatin exposure. In sum, modulation of EMD levels affects the viability, migration, and proliferation of wild-type p53 GBM cells treated with cisplatin, suggesting unknown roles in the DNA damage response and repair. This work highlights EMD as a potential regulator of GBM chemoresistance and a target for therapeutic intervention.

Purpose: Glioblastoma (GBM) remains associated with poor outcomes, with most recurrences occurring within the high-dose radiation field, suggesting persistent radioresistance. Exportin 1 (XPO1) inhibition with Selinexor has demonstrated radiosensitizing effects in preclinical models. We conducted a phase I trial to evaluate the safety, tolerability, and preliminary efficacy of Selinexor in combination with standard chemoradiation for newly diagnosed GBM. Methods: This investigator-initiated phase I dose-escalation trial (3+3 design) enrolled adults with newly diagnosed GBM or gliosarcoma. Patients received standard radiotherapy (60 Gy in 30 fractions) with concurrent temozolomide and escalating doses of Selinexor. Three dose levels were evaluated: 80 mg weekly (weeks 1, 2, 4, 5); 60 mg twice weekly (weeks 1, 2, 4, 5); and 60 mg twice weekly (weeks 1-6) throughout radiotherapy. The primary endpoint was determination of the maximum tolerated dose (MTD) based on dose-limiting toxicities (DLTs). Secondary endpoints included progression-free survival (PFS), overall survival (OS), patterns of failure, and patient-reported outcomes (MDASI-BT). Results: Eleven patients were enrolled. Median age was 58 years, and median KPS was 90. The MTD was established at Selinexor 60 mg twice weekly during weeks 1, 2, 4, and 5 of chemoradiation. Dose level 3 exceeded the MTD with two DLTs. Treatment compliance was high, with minimal missed radiotherapy fractions. Median PFS was 15.9 months (95% CI, 6.2 28.5), and median OS was 17.4 months (95% CI, 14.1 not reached). Most recurrences were central (5/6 evaluable patients). Notably, multiple cases of delayed pseudoprogression were observed at 5, 9, 10, and 23 months post-radiotherapy. Patient-reported symptom burden remained stable over time. Conclusions: Selinexor can be safely combined with standard chemoradiation in patients with newly diagnosed GBM, with an MTD of 60 mg twice weekly during select treatment weeks. Preliminary efficacy signals and an increased incidence of delayed pseudoprogression suggest a potential radiosensitizing effect. These findings support further investigation of Selinexor in larger, prospective studies.

GD2-CAR T cell therapy has demonstrated clinical benefit in patients with H3K27M+ diffuse midline glioma (DMG), but the durability of response has been limited in many patients1,2. To identify mechanisms of therapeutic resistance, we conducted longitudinal single-cell RNA and TCR sequencing of cerebrospinal fluid (CSF) lymphocytes from DMG patients receiving intravenous followed by sequential intracerebral GD2-CAR therapy, with lymphodepleting chemotherapy administered once prior to the start of CAR T cell therapy (NCT04196413). CSF GD2-CAR T cells manifested limited persistence and clonal expansion, while non-engineered CSF lymphocytes underwent significant clonal expansion and repertoire stabilization, ultimately dominating the CSF immune compartment. Concurrently, peripheral blood CD4+ and CD8+ T cells manifested anti-CAR immune reactivity targeting epitopes enriched within murine-derived and engineered junctional regions of the CAR construct. This was associated with appearance of circulating Human Anti-CAR Antibodies (HACAs) that bound cells expressing the GD2-CAR, as well as clonal expansion of CSF B cells which produced HACA which impeded the cytotoxic activity of GD2-CAR T cells. In several cases, appearance of circulating HACA temporally correlated with disease progression and across the patient population, and levels of circulating HACA inversely correlated with circulating CAR T cell persistence. These findings reveal robust induction of systemic and CNS adaptive T cell and B cell responses to GD2-CAR T cells following intravenous then sequential intracerebroventricular GD2-CAR therapy and provide strong evidence that anti-CAR immunity is a significant contributor to therapeutic resistance in this setting.

Background High-risk preoperative triage remains fragmented: existing tools often estimate risk without identifying modifiable mechanisms or linking classification to postoperative monitoring, destination planning, and rescue resources. This protocol describes implementation and evaluation of a Reserve-Stress-Rescue (RSR Framework), pathway that operationalizes perioperative high risk as a mismatch among patient physiologic reserve, procedural stress, and system rescue capacity. Approach RSR is a proposed clinician-facing, modular scoring framework for adults undergoing major surgery, especially patients with frailty, multimorbidity, poor functional capacity, anemia or malnutrition, cardiopulmonary disease, or limited postoperative support. Each domain, Reserve, Stress, and Rescue, is scored from 0 to 4 and recorded as both a three-part profile and a total score from 0 to 12. Scores map to Green, Amber, Red, and Crimson triage bands that trigger escalating actions, including targeted optimization, multidisciplinary review, anesthesia and surgical planning, postoperative destination selection, monitoring intensity, and predefined escalation criteria. Validation Plan The initial phase of this study received an exemption determination from the Yale University Institutional Review Board on June 3, 2026, under IRB Protocol ID 2000042729, with exempt categories 2(ii) and 4(iii), including a waiver of HIPAA authorization for access to and use of protected health information as described in the approved protocol. Evaluation will proceed in stages, assessing feasibility, interrater reliability, completeness, acceptability, discrimination, calibration, and clinical utility. Key outcomes include postoperative complications, unplanned escalation of care, intensive care utilization, failure to rescue, mortality, length of stay, triage burden, low-yield testing cascades, and management-changing pathway activation. Conclusion The RSR pathway reframes high-risk status as a modifiable interaction between vulnerability, operative insult, and rescue capacity rather than a fixed patient label. If feasible and valid, RSR may standardize high-risk identification, align perioperative resources with anticipated physiology, improve communication, and support safer, actionable shared decision-making.

Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy posing significant diagnostic challenges, particularly in distinguishing it from other adrenal tumors, such as adenoma and pheochromocytoma, due to overlapping imaging and biochemical features. Improved non-invasive tools are critically needed for earlier, more accurate classification of this rare cancer. This pilot study analyzed serum lipidomic profiles in ACC, pheochromocytoma, and adenoma patients versus healthy volunteers. The most significant alterations occurred in sphingomyelins (SM) and diacylglycerols (DG). All tumor samples showed reduced very-long odd-chain SM (e.g., SM 39:1, SM 41:1, SM 41:2) and elevated DG (e.g., DG 34:1, DG 34:2, DG 36:2). These abnormalities were most pronounced in malignant tumors: ACC and metastases (AUC = 0.933), followed by pheochromocytoma (AUC = 0.800) and adenoma (AUC = 0.711). ACC patients also exhibited specific lipid signatures with decreased alkyl/alkenyl phospholipids (e.g., PE O-38:5) and lysophosphatidylcholines (e.g., LPC 20:5, LPC 18:2) versus healthy volunteers, not observed in pheochromocytoma or adenomas. Ceramide species (e.g., Cer 42:2;O2, Cer 34:1;O2) were increased in ACC compared to the other tumor types. Incorporating lipid-to-lipid ratios (Cer/SM, Cer/DG) further improved statistical model accuracy. Compared to clinical biochemistry/oxidative stress (OS) parameters, lipidomic profiling showed superior discriminatory power in adrenal tumor diagnosis. The presented study shows the serum lipidomic profiling as a promising non-invasive method for distinguishing adrenal tumor subtypes (ACC, pheochromocytoma, and adenoma) from healthy individuals, with strong diagnostic potential for ACC.

Background: Medulloblastoma (MB) is the most common malignant brain tumour in children, and aggressive subgroups are frequently driven by the oncoproteins MYC or MYCN. Direct therapeutic targeting of MYC/MYCN has been challenging because of their intrinsically disordered protein structures. The aim of this study was to determine whether novel SE486-11 analogues (UNSW-SCs) can therapeutically target MYC/MYCN-driven MB. Methods: The anticancer activity of UNSW-SCs was assessed in MB cell lines with differential MYC/MYCN expression. Target engagement was evaluated using surface plasmon resonance and drug affinity responsive target stability assays. Blood-brain barrier penetration, MYC/MYCN protein degradation, cell cycle effects, apoptosis, DNA damage, and synergy with histone deacetylase (HDAC) inhibitors were examined. Therapeutic efficacy was evaluated in murine models of MYC- and MYCN-driven human MB. Results: UNSW-SCs showed potent anticancer activity, with preferential selectivity toward MB cells expressing high MYC/MYCN levels and IC50 values ranging from 0.22 to 1.18 M. The lead molecule, UNSW-SC-22, directly bound MYC, crossed the blood-brain barrier, and achieved a brain-to-plasma ratio of 1.44 at peak concentrations. UNSW-SC-22 induced MYC/MYCN-dependent cytotoxicity associated with enhanced proteasomal degradation, cell cycle arrest, apoptosis, and DNA damage. Combined treatment with HDAC inhibitors further reduced MYC/MYCN protein levels, increased DNA damage, and enhanced apoptosis. In vivo, UNSW-SC-22, either alone or with entinostat, significantly suppressed intracranial tumour growth and prolonged survival. Conclusions: UNSW-SC-22 is a brain-penetrant MYC/MYCN-targeting molecule with potent preclinical activity in MYC/MYCN-driven MB, supporting its development as a monotherapy or combination strategy with HDAC inhibition.

Coherent Raman spectroscopy enables label-free biochemical fingerprinting of live cells with subcellular resolution. We previously developed a machine learning framework capable of classifying glioma FFPE tissues using Raman spectral signatures. To accelerate live cell acquisition, we previously developed RADAR (Raman Spectral Analysis Using Deep Learning for Artifact Removal), a method that increases imaging speed by an order of magnitude while preserving spectral integrity. By integrating high-speed Raman imaging with supervised machine learning, we aimed to define unique biochemical fingerprints specific to cell type. We hypothesized that intrinsic biochemical composition alone is sufficient to distinguish cellular identity and tumor subtype. To test this, we generated metabolic maps of diverse brain-derived cell types--including astrocytoma, oligodendroglioma, and glioblastoma cells--using coherent Raman spectroscopy at single-cell resolution. Patient-derived brain tumor cell lines representing genetically heterogeneous backgrounds were analyzed. Samples were stratified by IDH1 mutation status (IDH1-mutant and IDH1-wild-type) and histologically classified as oligodendroglioma or astrocytoma. Raman spectral data were acquired from 286 live single cells across the two principal molecular classes, with further subdivision into two histologic subtypes within the IDH1-mutant group. Classification was performed using an XGBoost model with shallow tree depth (1-3), a 20% held-out test set, and grouped, stratified 5-fold cross-validation to control for sample-level bias. The machine learning framework distinguished IDH1-mutant from IDH1-wild-type cells with a ROC-AUC of 0.78 and further discriminated IDH1-mutant astrocytoma from oligodendroglioma cells with a ROC-AUC of 0.81. Feature importance analysis demonstrated that separation between IDH1-mutant and IDH1-wild-type cells was driven primarily by Raman peaks associated with protein amide bands, total NADH, unsaturated fatty acids, and heme-related vibrational modes. Within the IDH1-mutant class, discrimination between oligodendroglioma and astrocytoma was driven by lipid-rich vesicle signatures, protein/polyamide amide bands, and lipid-associated spectral features. Together, these findings support the feasibility of label-free, machine learning-assisted Raman profiling to resolve clinically relevant glioma subtypes at single-cell resolution. This scalable analytical framework provides a translational platform for investigating metabolic heterogeneity, therapeutic response, co-culture systems, and patient-derived organoid models.

Primary tumor biopsy in retinoblastoma carries an unacceptable risk of extraocular dissemination. As a result, children treated with eye-sparing approaches currently lack access to tumor-derived genomic information at diagnosis, limiting accurate risk stratification, preventing subtype-guided therapy, and obscuring insight into tumor evolution during conservative treatment. Aqueous humor (AH) liquid biopsy has emerged as a promising window into circulating tumor DNA (ctDNA) from eyes managed conservatively, yet its ability to comprehensively capture the genomic and epigenomic landscape of retinoblastoma and to deliver clinically actionable molecular stratification has not been rigorously evaluated. We analyzed 18 matched AH-tumor pairs using genome-wide methylation profiling, copy-number analysis, and targeted sequencing. AH samples consistently contained high ctDNA fractions (median 0.65), enabling robust detection of single-nucleotide variants, canonical copy-number alterations, and methylation signatures defining established retinoblastoma subtypes. Importantly, promoter methylation patterns associated with RB1 inactivation and optic nerve invasion were confidently detected in AH, highlighting that liquid biopsy enables functional interrogation of disease-relevant genes and pathways. To enable biopsy-independent molecular classification, we developed a methylation-based machine learning classifier trained on combined AH and tumor datasets (n=114). The classifier demonstrated exceptional performance, with AUCs of 0.96-1.00 in cross-validation and 0.97-1.00 in independent validation across 63 additional retinoblastoma cases. Together, these findings position AH liquid biopsy as powerful, minimally invasive platform for comprehensive molecular profiling in retinoblastoma. This work establishes the first clinically viable non-invasive molecular stratification tool for the disease, enabling pretreatment risk assessment and paving the way for next-generation precision diagnostics in eye-preserving care.

Moderate-to-severe traumatic brain injury (msTBI) is recognized as a chronic and evolving neurological condition characterized by progressive structural brain changes and persistent cognitive impairment. While prior studies have demonstrated widespread atrophy following msTBI, less is known regarding the longitudinal trajectory of gray matter (GM) changes during recovery and post-rehabilitation. The current study used longitudinal voxel-based morphometry (VBM) to characterize GM volume changes over a period of 9 months, in individuals with msTBI relative to healthy controls (HC). Associations between regional GM volume and neuropsychological functioning were examined. Twenty-eight participants (14 msTBI, 14 HC) completed MRI and neuropsychological assessments across three timepoints spanning outpatient rehabilitation and follow-up. Longitudinal VBM analyses revealed significant group and time interactions within subcortical and limbic regions. Relative to HC, individuals with msTBI showed lower GM volume in these regions at baseline, with trajectories that converged toward HC values (right hippocampus) or increased relative to HC over the rehabilitation period (bilateral pulvinar), whereas the right amygdala and inferior cerebellar vermis remained persistently reduced. Significant longitudinal improvements in memory and psychomotor speed during the rehabilitation period were demonstrated in msTBI. Greater (preserved) GM volume within the right hippocampus, thalamus, and bilateral pulvinar was associated with better performance across measures of verbal memory, processing speed, executive functioning, and cognitive flexibility. These findings suggest that msTBI is associated with dynamic structural brain changes involving subcortical, limbic, and cerebellar networks, and that the rehabilitation period was accompanied by relative volumetric stabilization in these regions and by meaningful cognitive improvement.

BackgroundTumor-associated neutrophils (TANs) are emerging as functionally heterogeneous and plastic cells in the tumor microenvironment. In immunologically cold tumors, elevated neutrophil abundance correlates with poor prognosis and resistance to immune checkpoint inhibition (ICI). Whether distinct anti-tumoral neutrophil states can be induced by different immunotherapies and how they relate to treatment efficacy remains unclear. MethodsUsing the syngeneic MOC2-huEGFR (M2h) mouse model of head and neck squamous cell cancer (HNSCC), we treated tumor-bearing mice with agonistic anti-CD40 monoclonal antibody (mAb) (aCD40), TNF, Cetuximab, or a combination of all three, designated Neutrophil Activating Therapy (NAT). In addition to evaluating anti-tumor efficacy, we performed single-cell multiomics RNA and protein sequencing, followed by bioinformatics analyses and flow cytometry validation. NAT-induced anti-tumor efficacy and related neutrophil states were also assessed in another cold tumor model, 9464D-GD2 neuroblastoma. Murine treatment-induced neutrophil gene signatures were then evaluated using clinical, proteomic, and transcriptomic data from HNSCC patients. ResultsFive transcriptionally distinct neutrophil states (N0-N4), including precursor state CD49d+ N4, were identified using the M2h model. N0 neutrophils (immunosuppressive/quiescent) dominated untreated tumors, but not in successful treatments. ISG+ N1 neutrophils and CCR3+ N3 neutrophils expanded by aCD40, TNF, and NAT treatment with anti-tumoral gene signatures and found more interacting with CD8+ T cells from bioinformatics analysis. N2 neutrophils reflected a recently established hypoxia-adapted state found in all treatments. ICAM1 (CD54) emerged as a marker of treatment-induced neutrophil activation, discriminating N1, N2, and N3 neutrophils from N0 neutrophils, validated by flow cytometry. In the 9464D-GD2 neuroblastoma model, NAT treatment also reduced the N0 dominance seen in untreated tumors in the HNSCC model but failed to induce anti-tumoral neutrophil states. In 23 HNSCC patients who received ICI therapy, ICAM1 protein expression in neutrophils trended toward association with responder status (TMA-level p=0.029), and ICAM1 neutrophil gene expression also trended toward association with improved overall survival in TCGA data (HR=0.75, p=0.059). ConclusionsDistinct immunotherapy-induced neutrophil states are defined by transcriptional profiles enriched in different functional pathways, associated with both anti-tumor and pro-tumor signatures. ICAM1 identifies activated neutrophils and potentially serves as a biomarker of ICI response in HNSCC, warranting further clinical validation. WHAT IS ALREADY KNOWN ON THIS TOPICNeutrophil heterogeneity has received increasing attention, with studies identifying antitumoral neutrophil populations, either at baseline or induced by treatment. Several effective treatment regimens involve an anti-CD40 agonist (aCD40) antibody, among them Neutrophil Activating Therapy (NAT), which combines aCD40, TNF, and a tumor antigen binding antibody designed to reprogram neutrophils. NAT could thus be particularly effective in cold, myeloid-rich tumors that are largely unresponsive to conventional immunotherapies such as checkpoint blockade, enacting these anti-tumoral effects through similar and different mechanisms; however, this has not been tested. WHAT THIS STUDY ADDSThis study adds a single-cell multi-omics framework for defining treatment-induced neutrophil heterogeneity in MOC2-huEGFR and 9464D-GD2 tumors, two immunologically cold models. It highlights ICAM1/CD54 and interferon-stimulated genes as markers of a dominant antitumor neutrophil state, while showing that neutrophil state composition variy across tumor models. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE, OR POLICYThese results support the efficacy of a myeloid-modulating therapy built around aCD40 and TNF in a cold murine head and neck cancer model, and to a lesser extent in a cold murine neuroblastoma model. ICAM1/CD54 expression in neutrophils was also identified as a promising marker of antitumor activity and treatment response. More broadly, this work suggests that incorporating aCD40 and/or TNF into existing treatment regimens could improve outcomes, while ICAM1/CD54-high neutrophils may serve as a useful therapeutic readout.